As a medical student, do you ever wonder what it’s like to specialize in pediatric orthopaedic surgery? Meet Heather Kowalski, MD, a pediatric orthopaedic surgeon and a featured doctor in the AMA’s “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out her insights to help determine whether a career in pediatric orthopaedic surgery might be a good fit for you.
The AMA Specialty Guide simplifies medical students’ specialty selection process, highlights major specialties, details training information, and provides access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database®.
Learn more with the AMA about the medical specialty of pediatric orthopaedic surgery.
“Shadowing” Dr. Heather Kowalski
Specialty: Pediatric orthopaedic surgery.
Practice setting: Academic medical center.
Employment type: Employed by University of Iowa Health Care, in Iowa City. University of Iowa Health Care is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Years in practice: Nine.
A typical day and week in my practice: I start my workday around 6:30 a.m., usually with a sign-out from the resident team about any new admissions and consults from the night before. Then we have educational didactics three mornings a week. After that, I either head up to the operating room for a day of surgery or to the clinic for a day of seeing patients in the office. I try to make it out of work in time for day care pick up and after-school activities as often as possible. I also travel to three other locations in the state for outreach clinics once a month each. This provides access to specialty care closer to home for patients in our largely rural state.
I typically have clinic two and a half days per week and surgery one to two days per week. The remainder of my time is spent working in my administrative roles for my department. I am the clerkship director for our medical student orthopaedic rotation, as well as the associate program director for our residency training program, so I have a lot of time-consuming commitments aside from my clinical practice. I take call for pediatric fractures one to two days per week and general overnight orthopaedic call two to three times per month. I average about 60 hours per week in the hospital.
The most challenging and rewarding aspects of pediatric orthopaedic surgery: The most challenging aspects are the same as those that one finds in other pediatric specialties: managing anxious parents, diagnosing young patients and working with non-neurotypical individuals who can’t tell you what hurts or where their problem is located. In addition, whatever intervention you discuss and recommend will impact that patient for the rest of their life.
One of the rewarding aspects is seeing a patient at one of the worst moments of their life after an accident or an injury and then seeing them returning to their active life a few weeks to a few months later. These are the moments that keep me going. The most rewarding thing is when a parent thanks me for the time, patience and care that I provided—not only to their child, but to them as well during a stressful and scary situation.
The impact burnout has on pediatric orthopaedic surgery: Burnout is clearly a problem in all areas of medicine. The continued increased expectations on surgeons to not only make diagnoses and provide surgical skills and expertise to address those diagnoses but also to add multiple layers of medical record documentation and clarification to convince an insurance company that what we recommend is in the best interests of the patient can be exhausting.
How my lifestyle matches, or differs from, what I had envisioned: My lifestyle is fairly close to what I anticipated when I was in training. I have a family and my husband is a urogynecologist, so we have a chaotic two-surgeon life. We work a lot but also take advantage of our free time as much as possible to stay connected and take care of our children.
In terms of how it differs, I did not anticipate that delaying starting a family until after training would be a very difficult challenge in our life, as we needed to go through reproductive assistance to build our family. This is an important aspect of what I have gone through that I make sure I discuss with my medical students and residents, just to help them prepare for their own futures.
I also did not anticipate that my parents would pseudo-retire so they could live near my immediate family and provide before- and after-school care for my young children. I am extremely grateful that I have that opportunity; it has been incredible to have that support. If that was not an option, I may have considered decreasing to half-time, but I am so happy that I have not needed to do that because I find my career incredibly rewarding.
Skills every physician in training should have for pediatric orthopaedic surgery but won’t be tested for on the board exam: Orthopaedic surgeons need to have an interest in the intersection of form and function and how modifying or changing one part of the body will impact other functions. They need to be able to think on their toes when plans A through C don’t work and be ready to move ahead with other options in the operating room or during a trauma situation. They need to gather data and make a plan quickly when the situation mandates but also be able to sit back and think through how their decisions will impact patients in the long term.
One question physicians in training should ask themselves before pursuing pediatric orthopaedic surgery: When you are in a room full of other orthopaedic surgeons, ask yourself: Are these my people? Could I see myself working with people like these on a regular basis for my entire career?
We work very closely with other orthopaedic surgeons, and it is important to be able to see oneself happily interacting with those who have chosen the specialty before. They don’t need to look like you or have come from your same background—I had zero female mentors before I chose to pursue orthopaedic surgery, but I had amazing mentors who I knew I would love to learn from and grow with by joining their amazing specialty.
Books, podcasts or other resources every medical student interested in pediatric orthopaedic surgery should be reading:
- “Peds Ortho Podcast.” This is a podcast put together by a group of pediatric orthopaedic surgeons who did their fellowships together at Rady Children’s Hospital–San Diego. Every month, they interview an author from the Journal of Pediatric Orthopaedics, and it is extremely educational and entertaining. You get to learn about their research and also their insight into other articles published in that issue.
- Orthopedic Secrets is geared toward medical students and what they might be asked on rotations.
- Miller’s Review of Orthopaedics is also a great reference, but a little dense for a medical student. It’s definitely geared toward residents, but it’s also a quick reference that I refer back to in order to brush up on something that I haven’t seen in a while.
Additional advice I would give to students who are considering pediatric orthopaedic surgery: Orthopaedic surgery is for everyone. Many students will still probably only ever think of orthopaedic surgeons as coming from a very specific demographic—one that does not look much like me. But, very slowly, we are actively changing what an orthopaedic surgeon looks like, and hopefully future students will see that diversity is the key to continued progress in our field.
If students are passionate about helping patients improve and restore their function and boost their quality of life, and if they love to be in the operating room, then orthopaedic surgery could be an excellent career choice.
